Individual
LADONNA RENAE BOWLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
12301 GRAPEFIELD RD, BASTIAN, VA 24314-4547
(276) 688-4331
(276) 688-4336
Mailing address
12301 GRAPEFIELD RD, BASTIAN, VA 24314-4547
(276) 688-4331
(276) 688-4336
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102203420
VA
207Q00000X
Family Medicine Physician
2128
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104800671
—
VA
05
—
3810014072
—
WV
01
—
P00708546
RR MEDICARE
WV
Enumeration date
03/06/2007
Last updated
02/14/2014
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